Over the past decade, Ontario has pioneered significant advances in health care services for transgender or otherwise gender-nonconforming people. While there has been a marked increase in the number of provincial Community Health Centres with trans-friendly policies, these advents have not been universal; the standard of health care available to transgender people in the province remains significantly poorer compared to what's available to other residents. “Being ahead of other provinces on these issues, unfortunately, still does not mean that Ontario's services are good,” said Anna Travers, director of Rainbow Health Ontario.
According to Travers, many transgender people who experience minor post-operative complications are advised to return to the clinic where they received surgery. Yet sex reassignment surgeries are currently unavailable in Toronto, and some patients travel as far as Europe and Asia to access them.
Scarlett Reeves, a 29-year-old Toronto hairstylist, was unable to access local treatment for minor complications following sex reassignment surgery in Montreal in 2012. Her family doctor referred her to numerous gynaecologists, but gave up after over 20 refused Reeves as a patient. Six months later, she was advised to go back to her surgeon in Montreal.
Toronto, however, is still an important hub for trans health care. “We come from all over the province, and sometimes country, to find treatment here,” said Caleb Nault, Project Coordinator for the Trans Men Who Have Sex With Men sexual health study. “To lessen the need to relocate to Toronto, the rural and non-metropolitan areas of Ontario really need to be making changes.” Over two-thirds of trans people in Ontario live outside of the GTA, meaning that accessible health care can sometimes be hours away- a reality which, in emergency situations, could be disastrous.
The resource capacity building initiated by Rainbow Health Ontario aims to address this gap in access. To date, 550 health care practitioners in cities across Ontario have been trained by Rainbow Health in post-operative care, cultural competency, and other issues relevant to transgender patients, said Travers.
Trans patients are technically protected from overt discrimination under the Ontario Human Rights Commission's Policy on preventing discrimination because of gender identity and gender expression, passed on April 14th of this year, but the onus remains on health care providers themselves to access specialized training. Many trans patients are doubtful that this is treated as a priority.
“I hate having to educate my doctors,” said Scarlett Palmer, a 25 year-old visual artist who has encountered significant roadblocks to accessing health care in Toronto. Nault pointed to preliminary research findings which show gay, bisexual, and queer trans men also report having to educate health providers in order to access sexual health services.
According to Nault, who has been involved with the Trans PULSE research project since 2008, demographics within trans communities have diverse needs and experiences in health care settings. “[These needs are] further complicated by experiences of racism in conjunction with transphobia; Aboriginal trans women have reported experiencing difficulties being treated in emergency rooms and hospitals, for example.”
“Ignorance on the part of service providers can be dangerous for patients- not only physically but also in terms of mental health and self esteem,” said Reeves. According to J., a former Toronto resident who requested anonymity, transgender health is a broad social issue that reaches beyond the medical establishments themselves. “Most importantly, I think housing is key to health,” they said. Transgender Canadians face a disproportionate risk of being homeless and living in poverty, and these factors not only negatively impact health but also present further roadblocks to accessing treatment, such as having no phone and no money for transportation.
As the rights of transgender people gain increasing social visibility and legal grounding, patients and advocates alike hope that programs such as those offered by Rainbow Health, the Sherbourne Health Centre, and the newly retrofitted trans-inclusive programming at the Centre for Addictions and Mental Health, will establish trans-specific health services as a core component in medicine province-wide. Rainbow Health is currently conducting an assessment of medical school curricula in the hopes of making transgender health a mandatory part of health care training; Trans PULSE, which was launched out of the Sherbourne Health Centre, provides a wealth of information on the nuances of trans needs and experiences that was previously unavailable to health care providers. Increasing the number of providers competent in transgender care could decrease the long waiting periods which, according to J. and Palmer, are currently the norm for trans patients.
“I think that trans care should be handled by primary care physicians, not by specialists, because it's not special,” said Ryan, a nurse practitioner with mixed experiences as a trans person accessing health care in Toronto.
“A trans person, particularly one who is established on a [medical treatment] regime already, is much easier to manage than [some patients with] other health conditions which primary care physicians have no issues taking on. Physicians can always consult with an endocrinologist if they have any specific questions, as they do with other specialists about other things.”
